骨髓瘤自体干细胞移植后中枢神经系统复发1例报道和文献复习  

Central nervous system relapses after autologous stem cell transplantation for myeloma:a case report and review of the literature

作　　者：王学文[1] 翟勇平[1] 刘海宁[1] 曹红琴[1] 周晓钢[1] 

机构地区：[1]南京军区总医院血液病科,江苏南京210002

出　　处：《现代肿瘤医学》2009年第5期932-935,共4页Journal of Modern Oncology

摘　　要：目的:报道1例多发性骨髓瘤(MM)自体干细胞移植(auto-SCT)后中枢神经系统(CNS)复发的病例,并进行文献复习。方法:1例IgAλ型MM患者经VAD方案3个疗程后进行Auto-SCT,2-3个月后临床和生化指标提示复发。病程中反复发作的溶骨性破坏性疼痛和多发性浆细胞皮下结节、肿块,遍及头部、肢体、躯干体表皮下及胰头部。采用多种联合系统化疗(SC)、蛋白酶体抑制剂硼替佐咪及放射治疗,化疗方案包括VAD、MOP、TCD、TDCEP方案,显示耐药、难治和复发。CNSMM的发病以MM明显缓解为契机,经鞘内化疗(IT)CSF瘤细胞和生化转阴。胰头浆细胞瘤梗阻性黄疸和CNSMM复发是该例死因。结果:本例自MM至CNSMM发病历时26个月,自Auto-SCT至CNSMM15个月。总生存期33.5个月,自Auto-SCT至死亡22.5个月,自CNSMM至死亡7.5个月。结论:MM患者CNS的累及是罕见的并发症,CNSMM的预后很差,据报道中数生存期仅1.5-2个月。CNSMM采用各种治疗措施(SC、IT和CI)的联合。CNSMM最有效的治疗方案尚不明了,但颅照射(CI)应包括在任何方式的治疗中。Objective：One case of central nervous system myelomatosis （CNS MM） after autologous stem cell transplantation was reported. The correlative literatures were reviewed. Methods：One patient with IgA h type MM was treated by 3 courses of VAD chemotherapy, followed by auto - stem cell transplantation was adopted. Clinical manifestations and blood biochemical markers suggested relapse after 2 - 3 months. Progressing osteolytic lesions and relapsed multiple subcutaneous nodes of plasma cells spreaded all over. Various combination hemotherapies, bortezomib and irradiation therapy were applied. Combination chemotherapy consisted of VAD, MOP,TCD ,TDCEP schedules. The case was refractory for various treatments after relapsed. The time of CNS MM diagnosis was at systemic remission of MM. Tumor cells in CSF were disappear and biochemical changes of CSF became normal by intrathecal chemotherapies （IT）. Obstructed jaundice induced by plasma cell tumor in head of pancreas and relapsed CNS MM were died cause. Results：Interval time from MM to CNS MM was 26 months,from auto - SCT to CNS MM was 15 months. Overall survival time was 33.5 months,from auto- SCT to death 22.5 months,from CNS MM to death 7.5 months. Conclusion：Involvement of the CNS in MM is very uncommon. The prognosis of CNS MM is very poor, median overall survival of 1.5 - 2 months according to reported. CNS MM is treated with various combinations and treatment schedules of SC ,IT and CI. The treatment schedules used for CNS MM are heterogeneous and a superior treatment schedule is ruled out. IC should be included in any treatment modality.

关 键 词：多发性骨髓瘤 自体干细胞移植 中枢神经系统骨髓瘤 

分 类 号：R733.3[医药卫生—肿瘤]